Perioperative outcomes in minimally invasive direct coronary artery bypass versus off-pump coronary artery bypass with sternotomy

Tekın, Ali; Arslan, Ümit

doi:10.5114/wiitm.2017.67679

Cited by 3 publications

(8 citation statements)

References 23 publications

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“…The 30-day mortality was 1.7% (n = 4) that is comparable to the published data of other centers (5,(10)(11)(12). Conversion to sternotomy (without cardiopulmonary bypass) was necessary in one patient (0.4%) that is acceptable and similar to published data (5,10). We observed one (0.4%) neurological event (minor stroke) postoperatively that is low.…”

Section: Discussionsupporting

confidence: 88%

“…In selected patients multi-vessel MIDCAB is feasible to treat lesions of LAD, diagonal branch or circumflex artery. Less surgical trauma, reduced operative bleeding, and fast recovery are associated with MIDCAB approach (4)(5)(6). Despite the advantages of MIDCAB procedure this technique has not been widespread in the routine cardiac surgery field.…”

Section: Introductionmentioning

confidence: 99%

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Postoperative results of minimally invasive direct coronary artery bypass procedure in 234 patients

Monsefi

Alaj²,

Sirat³

et al. 2023

Front. Cardiovasc. Med.

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IntroductionMinimally invasive approach in cardiac surgery has gained popularity. In order to reduce surgical trauma in coronary surgery minimally invasive direct coronary artery bypass (MIDCAB) has already been established. This technique has been introduced for revascularisation of isolated left anterior descending (LAD). It can also be performed for hybrid revascularisation procedure in multi-vessel disease.MethodsFrom 2017 to 2021, 234 patients received MIDCAB operation in our heartcenter 73% were male. Most of the patients had two or three vessel disease (74%). The average age of the patients was 66 ± 12 years mean. The left internal mammary artery (LIMA) was anastomosed to the LAD through left minithoracotomy approach. Multi-vessel MIDCAB (MV-MIDCAB) including two anastomoses (T-graft to LIMA with additional saphenous vein graft) was done in 15% (n = 35).ResultsThe average operation time was 2.3 ± 0.8 h mean. The 30-day mortality was 1.7% (n = 4). The average amount of packed red blood cells (pRBC) that was given intra- and postoperatively was 0.4 ± 0.8 units mean. The mean intensive care unit stay (ICU) was 1 ± 1.2 days. Three patients (1.3%) had wound infection postoperatively. The rate of neurologic complications was 0.4% (n = 1). Two patients (0.9%) had myocardial infarction and received coronary re-angiography perioperatively including stent implantation of the right coronary artery.DiscussionThe MIDCAB procedure is a safe and less traumatic procedure for selected patients with proximal LAD lesions. It is also an option for hybrid procedure in multi-vessel disease. The ICU stay and application of pRBC’s are low. Our MIDCAB results show a good postoperative clinical outcome. However, follow-up data are necessary to evaluate long-term outcome.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Postoperative results of minimally invasive direct coronary artery bypass procedure in 234 patients

Monsefi

Alaj²,

Sirat³

et al. 2023

Front. Cardiovasc. Med.

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“…Compared with these previous reports, our volume is considerably smaller, yet we demonstrate a significant a short‐term thirty‐day mortality and a long‐term 5‐year survival benefit among all‐comers with comparable perioperative MACE and improved 5‐year MACE‐free survival compared with a conventional sternotomy approach. This has been echoed in other experiences of similar volume . Ruel et al demonstrated in 91 patients no operative mortality or MACE in patients receiving an average of three bypass grafts via a minimally‐invasive approach.…”

Section: Resultsmentioning

confidence: 84%

“…Although our series is much smaller in comparison, an observed CVA and MI rate of 0% is quite satisfactory. Tekin et al in their similar volume series reported a significantly shorter LOS (4.3 vs 5.6, P < .01) and mechanical ventilation duration (5.1 vs 6.6 hours, P < .01). LaPierre et al demonstrated a lower incidence of atrial fibrillation and respiratory insufficiency in MICABG patients, although statistically insignificant, in addition to comparable graft reoperation, CVA, and MI rates between groups.…”

Section: Resultsmentioning

confidence: 99%

Minimally invasive single‐vessel left internal mammary to left anterior descending artery bypass grafting improves outcomes over conventional sternotomy: A single‐institution retrospective cohort study

et al. 2019

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Background: Coronary artery bypass grafting (CABG) can be performed through a variety of approaches. Minimally‐invasive CABG (MICABG) may reduce perioperative morbidity. Previous results demonstrate improved perioperative outcomes; however, adoption has been limited. Methods: The Society of Thoracic Surgeons (STS) database and electronic medical record at a single institution were reviewed for isolated left internal mammary to left anterior descending artery (LIMA‐LAD) bypass procedures performed between 2011 and 2018. Patients were grouped on the basis of operative approach, comparing sternotomy to non‐sternotomy (minimally‐invasive). Patient characteristics, perioperative variables, and short‐ and long‐term outcomes were compared. Primary outcomes included mortality and major adverse cardiac events (MACE). Secondary outcomes were morbidity. Results: A total of 42 MICABG and 54 conventional LIMA‐LAD procedures were performed with 95.2% of MICABG procedures performed by two surgeons. MICABG were more often elective (83.3 vs 38.9%, P < .001). STS risk scores predicted equitable mortality and morbidity for MICABG dependent on operative indication. MICABG was associated with fewer pulmonary complications (0.0 vs 11.1%, P = .033), in‐hospital events (11.9 vs 37.0%, P = .005), and shorter intensive care unit (34.1 vs 66.0 hours, P = .022) and total length of stay (3.7 vs 6.5 days, P = .002). There were no observed strokes, myocardial infarctions, or reoperations. MICABG patients demonstrated reduced thirty‐day mortality (0.0 vs 10.9%, P = .036) and improved Kaplan‐Meier 5‐year (95.2 vs 77.9%, P = .016) and MACE‐free survival (89.2 vs 63.9%, P = .010). Conclusions: Minimally‐invasive LIMA‐LAD CABG demonstrates improved early postoperative morbidity and a long‐term mortality benefit. In select patients, minimally‐invasive approaches to single‐vessel grafting may be beneficial when performed by experienced surgeons in the elective setting.

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“…7 Robotically assisted CABG has demonstrated comparable complication and long-term patency rates to convention sternotomy, with the added benefits of reduced surgical site infection rate, reduced surgical trauma, decreased need for blood transfusion, and shortened recovery times to full physical functioning. 8,9 However, despite best-practice selection of appropriate candidates using preoperative cardiac computed tomography (CT) imaging, conversion to sternotomy is often required as a bailout method during robotically assisted CABG procedures, occurring in 0% to 6.9% of patients. [10][11][12] Common indications for conversion include LITA injury or bleed, intramyocardial LAD course, pleural adhesions, and unsatisfactory Doppler flow measurements after completion of the anastomosis.…”

mentioning

confidence: 99%

Reason and Timing for Conversion to Sternotomy in Robotic-Assisted Coronary Artery Bypass Grafting and Patient Outcomes

Christidis¹,

Fox²,

Swinamer³

et al. 2018

Innovations�(Phila)

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Objective Conversion to sternotomy is a primary bailout method for robotically assisted coronary artery bypass grafting procedures. The aims of this study were to identify the primary reasons for conversion from robotically assisted coronary artery bypass grafting to sternotomy and to evaluate the in-hospital outcomes in such patients. Methods Prospectively collected data from February 2004 to April 2017 were reviewed for 72 patients (56 men; mean age = 63.8 years) who required conversion to sternotomy during a robotically assisted coronary artery bypass grafting procedure with planned endoscopic left internal thoracic artery harvest and anastomosis to the left anterior descending on the beating heart. Results The overall rate of conversion was 12.4% (72/581). Conversions occurred either during attempted endoscopic left internal thoracic artery harvest (31.9%), during endoscopic left anterior descending isolation (40.3%), during manual isolation and anastomosis of the left anterior descending (19.4%), or after anastomosis due to unsatisfactory flow (8.3%). Overall, the most common reason for conversion was an intramyocardial left anterior descending (43.1%). The median stay in the intensive care unit was 1 day (range = 0–20) and the median hospital length of stay was 5 days (range = 3–43). In-hospital complications included new atrial fibrillation (16.7%), need for blood transfusion (20.8%), mediastinitis (4.2%), postoperative myocardial infarction (2.8%), exploration for bleeding (2.8%), and 1 in-hospital death. Conclusions The reasons for conversion were primarily related to anatomical factors that created difficulties for endoscopic left internal thoracic artery harvesting and left anterior descending identification. Patients who required conversion to sternotomy from robotically assisted coronary artery bypass grafting demonstrated acceptable outcomes and low complication rates.

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Perioperative outcomes in minimally invasive direct coronary artery bypass versus off-pump coronary artery bypass with sternotomy

Cited by 3 publications

References 23 publications

Postoperative results of minimally invasive direct coronary artery bypass procedure in 234 patients

Postoperative results of minimally invasive direct coronary artery bypass procedure in 234 patients

Minimally invasive single‐vessel left internal mammary to left anterior descending artery bypass grafting improves outcomes over conventional sternotomy: A single‐institution retrospective cohort study

Reason and Timing for Conversion to Sternotomy in Robotic-Assisted Coronary Artery Bypass Grafting and Patient Outcomes

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